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Free healthcare from politics

The conference on healthcare reform to be held tomorrow by the Chamber of Commerce, Enterprise and Industry is an important initiative in the process of consultation on the sector. It will not lead to any definite development in the near future. But it should serve to highlight several concerns, most of which are already well known.

The main speeches, I rather suspect, will cover the public’s major immediate concerns. These relate to overcrowding in all the hospitals, not just Mater Dei, and the usual crisis that will hit the main hospital over the coming weeks as colds and influenza grow as does the waiting time in the emergency department and, well beyond that, for most operations.

These are matters for planned action. The Health Minister will touch on such plans, which need to be drawn up expeditiously and then carefully implemented as soon as possible. These plans will include reform, for instance to free hospital beds through recourse to retirement homes, and to ease waiting lists by outsourcing operations to the private sector.

But at the heart of reform of the sector lies a key question which must be answered and action taken before it gets worse. The question is: how can the health sector be made sustainable?

The implicit premise to the question is obvious: the present health system, although misleadingly promoted as being free, is unsustainable.

Public health services offer wide areas of admirable welfare, but it is not quite free in total. Thousands of medicines are included in the government formulary, leading to much waste. Yet, one comes to a point where essential medicines costing a great deal of money are not in the formulary. The patient has to buy them or do without them.

Those who have health insurance might have the expense or part of it refunded. I say ‘might’ because insurance tends to cover acute treatment but stops if it becomes chronic – when you most need support, it is not there. If not covered by insurance one has to meet the expense directly. Some can do that. Others, no matter how hard they try, cannot.

I know from experience that this is so in cancer cases. It might also be the case in other cruel areas. Nowhere else are the have-nots so harshly exposed.

Reform should and can tackle this by ensuring that really free medicines are not abused of. I think both the minister and the Bishop of Gozo will have something to say about that at tomorrow’s conference.

Policy direction will not change as demanded by circumstances

The reform that is needed has to start with the application of sense and efficiency to the existing structures to ensure honest value for money. That done, I am among those who believe that public health care will still be unsustainable if left as it is now. Pressures outside the control of any government, including an ageing population and increasing longevity, will expose the fissures in the system.

Having cut costs as far as possible these fissures can be addressed either by throwing more financial resources at them, raising them through higher social security contributions, or by making public health care subject to some form of payment.

Aside from the minister and the Bishop of Gozo, tomorrow’s conference will be addressed by the Opposition spokesperson on Health and by the chairman of Alternattiva Demokratika.

It will be interesting to see whether the minister and his shadow spokesman will at least nod towards the inevitable, when some form of health payments will have to be introduced.

Both are honest, clear-minded gentlemen. Both are also politicians. So far the common political line has been that public health must remain free and that higher economic growth should ensure that can be done. The argument regarding economic growth is wider than healthcare, vast as that area is. It covers pensions and stipends, as well as the need to extend better protection to those below the poverty line or in danger of getting there.

It is going to take a lot of growth for all the demands for rising expenditure to be met without recourse to new taxation.

And that is without taking into account the need for capital outlays. Aside from the massive recurrent budget and normal capital outlays, for instance, health will soon have to include a provision for a new hospital, even if beds are freed by moving social cases from Mater Dei Hospital and Mount Carmel Hospital.

In one form or another all this will be defined during tomorrow’s conference. My sceptical assertion that no action to introduce payments in the short to medium term will be taken does not arise from any suggestion that politicians are not aware of the current and growing problem. They are aware. But they compete with each other to solemnly swear that healthcare will remain free under their watch.

As indicated, it isn’t as free as made out to be. And as also predicted unsustainability will become more obvious as time passes, whoever is running the country. Unless there is a bipartisan approach to what is a national challenge, policy direction will not change as demanded by circumstances.

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